While braces are a tried and true method for achieving a more attractive smile, they may also give rise to problems with dental disease. This is because their hardware — the brackets and bands that serve as tracks for the tensioning wires — make it more difficult to access the tooth and gum surfaces to clean away plaque. This thin film of food remnant may then become a haven for bacteria that cause gum disease or tooth decay.
One of the more common conditions to occur while wearing braces is gingivitis. This is an initial inflammation of the gum tissues caused by bacterial plaque that hasn’t been removed by brushing or flossing. As the inflammation grows unchecked, the infection could advance deeper into the tissues to become a more serious form of gum disease that threatens the survival of affected teeth.
Difficult as it may be for those wearing braces, the best way to avoid gingivitis is through more thorough oral hygiene practices. Fortunately, there are many hygiene products that can help you get around many of the access difficulties posed by braces. Smaller toothbrushes known as interproximal brushes and floss threaders, small aids that thread dental floss under braces wires, can access the spaces between teeth more readily than conventional brushes or floss. Water flossers (which use water under pressure to remove plaque between teeth) and motorized toothbrushes can further increase efficiency. We can also reduce bacterial growth in the mouth if need be with prescription-strength antibacterial mouthrinses.
If, however, gingivitis or gum overgrowth (another common occurrence during orthodontic treatment) continues to be a problem, we may need to take other actions including surgery. In extreme cases, the braces may need to be removed to adequately treat the gums and allow them time to heal before proceeding with orthodontics.
Extra care with daily hygiene and regular dental checkups and cleanings in addition to your orthodontic visits will help keep gum problems at bay while you’re wearing braces. Taking this extra care will stop or minimize the effect of disease as you continue on to the ultimate goal of your orthodontic treatment — a more beautiful smile.
If you’re facing cancer treatment, we wish you the best outcome possible. Treating this disease has advanced tremendously in recent decades, but the available options are still often challenging to endure. It will be your primary focus for the foreseeable future.
As a dental provider we also want you to be aware how the two main treatments, chemotherapy and radiation, could adversely affect your teeth and gums, especially if you’re receiving radiation therapy near the head and neck. The aim of cancer treatment is to attack and destroy cancer cells to prevent their growth. Unfortunately, it can also destroy neighboring healthy cells and lead to harmful consequences in different parts of the body, including the mouth.
Salivary glands, for example, are especially vulnerable to damage during cancer treatment. This could create a situation where the mouth no longer produces adequate saliva flow, leading to a condition called xerostomia or dry mouth. Besides a lot of discomfort, restricted saliva flow can also increase your risk of tooth decay and other dental diseases. This is because saliva is the body’s acid neutralizer (acid can erode tooth enamel) and its first line of defense against microbial infection.
To guard against this, it’s important to support salivary flow as much as possible if you experience dry mouth symptoms during treatment (as well as beyond—it’s possible the damage to these glands could be permanent). Since some medications also contribute to dry mouth, you should speak with your physician about the prescriptions you’re taking: if any have dry mouth side effects ask if there’s an alternative drug without these side effects. You should also drink more water during the day and especially when taking medications. And consider substances like xylitol gum that can help boost saliva flow.
Unfortunately, it may not be possible to fully avoid the effects of these treatments on your teeth and gums. So, be sure you keep up daily brushing and flossing and see your dentist regularly for cleanings and checkups. If necessary, there are a number of restoration options to restore your smile after you’ve completed your treatment.
If you’re over age 30 there’s a fifty percent chance you have periodontal (gum) disease—and you may not even know it. Without treatment this often “silent” bacterial infection could cause you to lose gum coverage, supporting bone volume or eventually your teeth.
That’s not to say there can’t be noticeable symptoms like swollen, red, bleeding or painful gums. But the surest way to know if you have gum disease, as well as how advanced it is, is to have us examine your gums with manual probing below the gum line.
Using a long metal device called a periodontal probe, we can detect if you’ve developed periodontal pockets. These are gaps created when the diseased gum’s attachment to teeth has weakened and begun to pull away. The increased void may become inflamed (swollen) and filled with infection.
During an exam we insert the probe, which has markings indicating depths in millimeters, into the naturally occurring space between tooth and gums called the sulcus. Normally, the sulcus extends only about 1-3 mm deep, so being able to probe deeper is a sign of a periodontal pocket. How deep we can probe can also tell us about the extent of the infection: if we can probe to 5 mm, you may have early to mild gum disease; 5-7 mm indicates moderate gum disease; and anything deeper is a sign of advanced disease.
Knowing periodontal pocket depth helps guide our treatment strategy. Our main goal is to remove bacterial plaque, a thin film of food particles that collects on teeth and is the main cause and continuing fuel for the infection. In mild to moderate cases this may only require the use of hand instruments called scalers to manually remove plaque from tooth surfaces.
If, however, our periodontal probing indicates deeper, advanced gum disease, we may need to include surgical procedures to access these infected areas through the gum tissue. By knowing the depth and extent of any periodontal pockets, we can determine whether or not to use these more invasive techniques.
Like many other health conditions, discovering gum disease early could help you avoid these more advanced procedures and limit the damage caused by the infection. Besides daily brushing and flossing to remove plaque and regular dental checkups, keep watch for signs of swollen or bleeding gums and contact us for an appointment as soon as possible. And be aware that if you smoke, your gums will not likely bleed or swell—that could make diagnosis more difficult.
If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Understanding Periodontal Pockets.”
People who’ve lost all their teeth (a condition known as edentulism) face a decision on how to restore their lost function and appearance. And there are a number of options to consider.
A fixed bridge supported by dental implants, for example, is a good choice for patients who still have sufficient bone structure in their jaw. It’s not a good choice, however, for those with the opposite situation — who’ve experienced significant bone loss which has also affected their facial structure. For them, there’s a better alternative that also uses implants for support — the overdenture.
An overdenture is similar to a traditional denture, in that it’s made of life-like crowns permanently set in denture plastic, and may either partially or fully cover the roof of the mouth. The main difference, though, is that unlike traditional dentures which rest for support on the gum ridges, an overdenture is supported by strategically placed implants that the denture fits over and connects to — hence the name “overdenture.”
There are a number of advantages for an overdenture, especially for patients with bone loss. A removable, implant-supported denture can be designed to replace lost tissues that have altered facial appearance — to “fill in” the face and restore aesthetic harmony. Patients who’ve previously worn dentures will also often find their speech better improved than with fixed bridgework.
Because it’s removable, an overdenture and the underlying gums are easier to clean, which helps inhibit disease and lessen further bone loss. It also allows you to properly care for the denture, which can extend its longevity and reduce future potential maintenance and replacement costs.
If you would like to consider removable overdentures as an option, you should begin first with a thorough oral exam that includes evaluating the status of your bone, jaw and facial structure. From there we can advise you if overdentures are the best choice for you.
If you would like more information on overdentures and other restoration options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fixed vs. Removable.”
Dental implants are today’s closest restorative facsimile to natural teeth. And they’re versatile: not only can they replace single teeth but they can also support bridges or dentures.
But since one of their crucial components is made of metal, are you out of luck obtaining this state-of-the-art dental restoration if you have a metal allergy?
The answer is: probably not—it’s rare for implants to cause an allergic reaction. Still, metal allergies can be a potential problem within your mouth as with other areas of health.
An allergy originates from the body’s necessary response to potentially harmful microorganisms or substances. Sometimes, however, this response becomes chronic and exaggerated, creating an allergy. People can have allergies to nearly anything with responses ranging from a minor rash to a potentially life-threatening multi-organ system shutdown (anaphylactic shock).
A small number of people have allergies to particular metals. One of the most common is nickel, which affects an estimated 17% of women and 3% of men; cobalt and chromium are also known to cause allergies. Consumer exposure, particularly metal contact with the skin through jewelry or clothing, is the most prevalent, but not the most concerning. That’s reserved for metal allergies related to medical devices like coronary stents or hip and knee prostheses. And in dentistry, there are rare occasions of inflammation or rashes from metal amalgam fillings.
Which brings us to dental implants: the main metal post that’s inserted into the jawbone is usually made of titanium. It’s the metal of choice for two reasons: it’s bio-compatible, meaning the body normally accepts its presence; and it’s osteophilic, which means bone cells readily grow and adhere to it, a major reason for implant durability.
While it’s possible for someone to have an allergy and subsequent reaction to implants with titanium, the occurrences appear to be extremely low. In one study of 1,500 patients, titanium allergies were estimated to be a factor in implant failures in less than 1% of those studied.
Even so, if you have known metal allergies you should make sure your dentist knows. Being aware of all the facts will help them recommend the best tooth replacement choice for you—and hopefully it will be dental implants.
If you would like more information on dental implant restorations, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Metal Allergies to Dental Implants.”
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